Provider Demographics
NPI:1821401191
Name:FLORIDA WELLNESS INSTITUTE OF PINELLAS COUNTY, LLC
Entity Type:Organization
Organization Name:FLORIDA WELLNESS INSTITUTE OF PINELLAS COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GATZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-449-2008
Mailing Address - Street 1:1000 S FORT HARRISON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3906
Mailing Address - Country:US
Mailing Address - Phone:727-449-2008
Mailing Address - Fax:727-449-1499
Practice Address - Street 1:1000 S FORT HARRISON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3906
Practice Address - Country:US
Practice Address - Phone:727-449-2008
Practice Address - Fax:727-449-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 86204208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty